The prevalence of under nutrition and associated factors among pregnant women attending antenatal care service in public hospitals of western Ethiopia

Background Pregnancy is a time when the body is under a lot of stress, which increases your dietary needs. Under nutrition is a worldwide health issue, especially among pregnant women. Malnutrition during pregnancy can result in miscarriages, fetal deaths during pregnancy, pre-term delivery, and maternal mortality for both the mother and her fetus. Therefore, this research aimed to assess the prevalence of under nutrition and associated factors among pregnant woman attending antenatal care services at public hospitals in west Ethiopia. Objective To assess the prevalence of under nutrition and associated factors among pregnant women attending Antenatal Care service in Public Hospitals of western Ethiopia. Methods Facility based cross-sectional study was conducted from April 10 to May 10, 2020 among 780 pregnant mothers. The study participants were selected by systematic random sampling methods from antenatal care clinics of the hospitals. Interviewer administered structured questionnaire was used to collect the data and Mid-upper arm circumference, height and weight were measured to determine the magnitude of under nutrition among the study participants. The data were entered to Epi Info version 7.2.3, and then exported to SPSS version 24 for analysis. Multivariable logistic regression was used to identify independent predictors considering adjusted odd ratio (AOR) at p-value ≤ 0.05 to measure the strength of association between dependent and independent variables. Result The prevalence of under nutrition among pregnant women was found to be 39.2% (95%CI: 35.7%, 42.6%). Rural residence [(AOR = 1.97, 95% CI: (1.24, 3.14)], substance use [(AOR: 3.33, 95% CI: (1.63, 6.81)], low dietary diversity of women [(AOR = 7.56, 95% CI: (4.96, 11.51)], mildly food insecure household [(AOR = 4.36, 95% CI: (2.36, 8.79)], moderately food insecure household [(AOR = 3.71, 95%CI: (1.54, 8.79), and severely food insecure household [(AOR = 6.96, 95% CI: (3.15, 15.42)] were factors significantly associated with under nutrition. Conclusion The study showed that the prevalence of under nutrition is very high among pregnant women. Factors associated with under nutrition of pregnant women were rural residency, household food insecurity, dietary diversity and substance use. All concerned bodies should made efforts to reduce the risk of under nutrition by reducing substance use and improving household food security there by to increase women’s dietary diversity.

The study protocol was approved and permission was obtained from Wollega University. An official letter of co-operation was written to the selected Public Hospitals of West Wollega Zone Administration. Information on the studies, including purpose and procedures was given for participants. Written or verbal consent was obtained from each participant. In order to protect confidentiality, names or identifications were not included on the written questionnaires. Identification of the respondents was only through numerical codes.

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Methods: Facility based cross-sectional study was conducted using systematic random sampling techniques.

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Interviewer administered structured questionnaire was used to collect the data and Mid-upper arm circumference,

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height and weight were measured to determine the magnitude of under nutrition. Then, the data were analyzed using 32 logistic regression with 95% confidence interval (CI). Besides, the results of data analysis were presented using 33 appropriate descriptive statistics.  Under nutrition is the result of inadequate intake of food in terms of either quantity or quality, poor utilization of 48 nutrients due to infections or other illnesses, or a combination of these immediate causes [1]. Pregnancy strongly 49 depends on the health and nutritional status of women and a high proportion of pregnant women are affected by poor 50 nutrition which leads them to unhealthy and distress conditions. Under nutrition goes beyond calories and signifies 51 deficiencies in any or all of the following: energy, protein, and/or essential vitamins and minerals [2].

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Pregnancy constitutes states of considerable physiological stress, which cause increased nutritional demands. If 53 these demands are in adequate, not only the nutritional status of the subject will affect, but also the course of

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The prevalence of undernourishment-the percentage of the population without regular access to adequate calories-

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In developing countries, it has been estimated that poor nutritional status in pregnancy accounts for 14% of fetuses and mortality are continued [9].

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Under nutrition among women in reproductive age is significantly higher in Africa due to chronic energy and/or

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An institution-based cross-sectional study design was carried out. This study was conducted in public general 96 hospitals of the Oromia region. The study was conducted in five public hospitals in the zone were the selected study 97 area. This study was conducted in Public Hospitals of western Ethiopia from April 10 to May 10, 2020.

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The source populations were all third-trimester pregnant women who were coming for delivery and antenatal care 100 visits in the selected public general hospitals of the Oromia region. Third-trimester pregnancy women who were 101 coming for antenatal care visits in general public hospitals of the Oromia region western part were selected as the 102 study population.

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All selected third-trimester pregnant women who were coming for ANC in public general hospitals during the study 105 period were included, whereas pregnancy women with bilateral edema, who were seriously sick and unable to 106 respond to the interview, were excluded from the study.

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Sample size was calculated using double population proportion formula by assuming precision OR (Odd ratio) 1.52

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The sample size was allocated proportional to their average monthly client flow. Systematic sampling was used to

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Under nutrition was taken as a dependent variable and compared against each independent variable for association.

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Bivariable logistic regression was done to identify factors associated with nutritional status of pregnant women.

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Accordingly, household food insecurity, low dietary diversity, poor prenatal feeding habits, number of pregnancy,

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In this study, respondents who were from food insecure household shows more at risk of malnutrition than those 286 from food secure households. Our finding of an increased prevalence of maternal undernutrition in food insecure 287 households may reflect inequitable intra-household food allocation whereby the nutritional needs of the child and/or 288 other members of the household are prioritized over those of the mother. As evidenced from 2019 FAO food 289 insecurity report that, household food insecurity was found to be associated with more than one form of malnutrition

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 This study used anthropometric measure to assess nutritional status of pregnant mothers and the effect of 311 technical error was not ruled out that may affect the reliability of result.

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 As it is institutional based study, the finding of this study does not fully indicate the characteristics of 313 respondents at community level which means it is not generalized beyond study population.

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Based on the finding of this study the following recommendations were forwarded.

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 Governments should adopt coherent policies, which foster cross-sectoral cooperation and strategies to avert 323 the problem of undernutrition among pregnant women.

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 Policy makers and implementers should make programs that improve food security status at household 325 level to increase access to high nutritious food and variety of foods among poor.

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 Essential investments must be made into nutrition-sensitive programme in other areas such as agriculture, 327 education, water and social protection.